Fla. Admin. Code Ann. R. 65A-1.707 - Family-Related Medicaid Income and Resource Criteria

(1) The Department uses the Modified Adjusted Gross Income (MAGI) based budgeting methodologies as defined in 26 U.S.C. 36B(d)(2)(B) to determine the financial eligibility of individuals applying for Medicaid. Resources are not considered as part of the eligibility determination for individuals whose eligibility is determined using MAGI methodologies. MAGI methodologies will not apply to the following:

(a) Individuals whose eligibility for Medicaid does not require a determination of income by the Department, including individuals receiving Supplemental Security Income (SSI).

(b) Individuals who are age 65 or older when age is a condition of eligibility.

(c) Individuals whose eligibility is being determined on the basis of being blind or disabled.

(d) Individuals who request coverage for long-term services and supports, including nursing facility services, or individuals who request a level of care in any institution equivalent to nursing facility services, or individuals who request home and community-based services provided under a Medicaid waiver.

(e) Individuals who are being evaluated for Medicare cost sharing assistance.

(f) Individuals who are being evaluated for coverage as SSI-Related Medically Needy.

(2) Countable Net income is defined as: The sum of income counted for the assistance group based on the number of individuals and their income included in the SFU, except as provided in 42 C.F.R. § 435.603(d)(4). To determine eligibility using MAGI-based income criteria, an amount equivalent to the MAGI five percent of the Federal Poverty Level (FPL) is subtracted from the countable income of the individual based on the size of the SFU. The standard disregard as defined at 65A-1.701(67) is subtracted from total gross income to determine countable net income. The MAGI five percent is not applied if the countable net income of the individual is at or below the income limit for the coverage group. This disregard is not applied in Medically Needy.

(3) MAGI-based income is defined as: Income calculated using the same financial methodologies used to determine modified adjusted gross income as defined in section 26 U.S.C. 36B(d)(2)(B), with the exceptions specified in 42 C.F.R. § 435.603(e).

(4) SFU: Refer to 65A-1.705(2), F.A.C., for information on households.

(5) Income standard for infants and children under age 19: The maximum income standard for infants under age one is 200 percent countable net income of the MAGI converted FPL and the maximum income standard for children ages one through 18 is 133 percent of the FPL, pursuant to Florida's Medicaid State Plan, Approved Conversion Thresholds, 6/27/13, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11664 and https://ahca.myflorida.com/Medicaid/stateplan_aca.shtml.

(6) Income standard for Parents and Caretaker Relatives: The maximum income standard for parents and caretaker relatives is the state's Aid to Families with Dependent Children (AFDC) payment standard in effect as of July 16, 1996, converted to a MAGI equivalent standard included in Florida's Medicaid State Plan, Approved Conversion Thresholds.

(7) Income standard for children ages 19 and 20. The maximum income standard for children ages 19 and 20 is the state's AFDC payment standard in effect as of July 16, 1996, converted to a MAGI equivalent standard included in Florida's Medicaid State Plan, Approved Conversion Thresholds.

(8) Income standard for pregnant women. The maximum income standard for pregnant women is 185 percent of the FPL as specified in Florida's Medicaid State Plan, Approved Conversion Thresholds.

(9) Medically Needy Income Level (MNIL). The Department deducts the MNIL, as provided in 65A-1.716(2) F.A.C., from the SFU countable income to determine the amount of Share of Cost (SOC) available to meet medical care and services each month.

(10) Exceptions to MAGI-based income referenced in 42 C.F.R. § 435.603(e).

Notes

Fla. Admin. Code Ann. R. 65A-1.707

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS.

New 10-8-97, Amended 2-15-01, 11-23-04, 2-20-07, 5-6-08, 6-4-12, Amended by Florida Register Volume 46, Number 048, March 10, 2020 effective 3/25/2020.

New 10-8-97, Amended 2-15-01, 11-23-04, 2-20-07, 5-6-08, 6-4-12, 3-25-20.